The Importance of Peer Support

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What a privilege to present again to a group of smart, creative, fun, and engaging designers on Friday.  This time I was asked to address burnout, as so many folks are feeling overwhelmed and stressed.  I did my homework on stress and burnout in the creative fields, and found enough similarities in medicine to feel like a credible speaker.  “It’s not just a job, it’s a way of life,” seemed to capture how we see our respective vocations.

I presented a brief mini-lecture on self-care practices, including habit formation and maintenance in the 5 reciprocal domains of health, and narrative awareness.  The latter is always something we can do when we find ourselves in untenable circumstances:  Ask ourselves what story we tell about the situation, how that story compounds our suffering, and then tell a new story that does nothing to change the objective reality, but can dramatically improve our personal experience of it.  I have learned from work in physician burnout that people don’t just want to be told how to fix themselves.  They want someone to address the problems of the system that oppresses them.  So that’s where I tried to go next.

I started with an Appreciative Inquiry (AI) exercise.  In small groups, I asked participants to share team success stories, and listen for recurring themes around what’s already great about their teams, their work, and their organization.  Words like openness, flexibility, and “we have leaders, not bosses” made the Post-It easel list.  Then, in this headspace, I asked the groups to identify issues they wanted to address.  Instructions were to find important, urgent, and solvable challenges.  Guiding questions included, “Why will the organization be better if it’s addressed?” and “What does better look like?”

Similar to the AI results, common issues arose from multiple groups.  There was general consensus, reviewing the list at the end of 20 minutes, that overall work satisfaction would improve with less digital and more face to face communication, better project clarity, and taking better care of the shared spaces.  I would meet with team leaders and show them the list later in the day.

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When I opened the floor to questions, a self-proclaimed ‘Debbie Downer’ presented a query that I will ponder for many months as I prepare upcoming talks:  “When you ask someone how they’re doing and they say they feel like they’re drinking from a firehose, telling them to adjust their attitude is probably not helpful…  How can we change things that are not in our control?” The Universe had prepared me for this question by sending a new mentor who taught me to ask, “Who owns the things we don’t control?”  Thank you, my loving Cosmos.

I only partially answered Debbie’s question by suggesting she think about how she might influence the owner(s), how she might impact decisions being made in those spaces.  I segued too quickly, I’m afraid, to the question that I wanted to ask the group:  “When someone asks you how you are and you express that you are overwhelmed and drowning, what is a helpful response?”  I thought the discussion that ensued was productive…  It seemed to stimulate people’s intrinsic empathy and compassion.  We recognized the importance of feeling connected, that I’m not the only one feeling this way.  People recognized the relief found in just speaking aloud the list of stressors to a sincere and empathic listener.  We also talked about being prepared to hold space for any potential answer when we ask, “How are you?”  Even if we have no control over the flow out of the fire hose, maybe we can take turns holding the nozzle steady, and at a slightly oblique angle for each drinker, so it doesn’t have to knock us all over when we try to take a gulp.

I had a chance to talk to Debbie a little later (Cosmos offering me a second chance, Thank You Again), and we agreed that stress and burnout, in both medicine and design, are best addressed at both the individual and systems levels.  We can each start with personal accountability for our own experience of the system.  Then we can decide how we show up in the system each day.  We can choose, at any time, to either participate passively in the status quo (which is what we all need to do sometimes), or find a way, however small, to advocate effectively for change.

The latter is much better done with peers, with friends.  Take time to connect (no lunch meetings, let’s just eat together!).  Share stories.  What do we love about this work?  What’s already great?  How could it [realistically] be even better?  How can we help one another, including our leaders, envision and pave the way there?  Who else needs to be enrolled?

My meeting with the team leaders was less structured.  I worried that they left feeling disappointed because I did not offer more concrete advice on personal resilience practices for leaders, and ‘how to lead’ teams in burnout.  But over the hour, I felt no desire or need to lecture.  I queried various aspects of their self- and team awareness, personal resilience practices, and communication.  We briefly reviewed the issues list from the morning workshop, and I left with confidence that they would take it seriously.  It also occurred to me that these designated leaders were already supporting one another in their efforts to lead intentionally, effectively, and compassionately.  Maybe they have also felt overwhelmed sometimes.  Maybe it was also good for them just to talk it out with each other this day.  Maybe we can all do this for one another a little more often.

 

We Are Really Bad At This

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Sylvan Dale Guest Ranch, Loveland, Colorado, March 2019

How many truly meaningful and fulfilling conversations do you have in a day?

How many such relationships do you have?

Though I wrote my Pit Crew post almost a year ago, its ideas recur regularly.  I have linked to it on multiple subsequent posts.  I share it with patients and reference it in conversations often.  My patients are leaders of large corporations and organizations.  My colleagues and I lead teams in the hospital, the medical group, and the medical school.  My friends lead their families and communities.  When I think about our health and its consequences, it’s about taking care of those for whom we are responsible, ourselves included.

Are you generally the one who always takes care of others?  How does this affect your style and effectiveness as a leader?

Who Takes Care of You?

I estimate that about 20% of the time when I ask this question, my patients say that nobody takes care of them; they do it themselves.  They don’t mean that nobody cares about them.  It’s that they don’t really depend on anyone for counsel and/or support.  They hold everything together themselves.  I always have mixed feelings when the conversation takes this turn.  On one hand I feel admiration and respect, especially when they seem generally healthy—apparently unaffected by physical, mental, and emotional dysfunction.  On the other, I get curious.  How do they sustain this Lone Ranger method?  And what does it cost them?  I believe we all need tight, vulnerable, and safe connections through which we can get raw and real, and work through life’s ultimately messy sh*t.  We need others, even if it’s only one or two, to help us truly hold it all together.  My default assumption is that if we don’t have such connections, we are not living into our full potential.

And today I feel cynical.  I think we are getting really, really bad at taking care of each other.

Driving to work this week I wondered to myself, why do we feel the dearth of mental health services so acutely these days?  Is it that more of us are living on the psychological razor’s edge of mental health and illness?  Are we not diagnosably mentally ill but simply, profoundly, stressed to our limits of sanity and function?  Is that why none of my patients can get in to see a psychiatrist or therapist for weeks to months?  Is that why physicians are increasingly leaving the profession and killing ourselves?  Why do we feel so hopeless?

It’s easy to blame social media.  And I do, partially.  The cruelest irony lives here.  My non-evidence based impression is that cyberbullying bears equally life-threatening consequences as face to face bullying.  If you know of evidence to support or refute this premise, please share.  Negative interactions on social media, which rage so easily like wildfires, are now understood to contribute significantly to the rise in loneliness across the country.  Worse, cultivating truly positive relationships via social media is much harder and more complex, even deceptive.   So on balance the risks and harms of social media may far outweigh the benefits.  There simply is no substitute for personal, physical contact, for sharing the same space, breathing the same air, experiencing another’s full presence.

Worse yet, too often we can’t even get that right!  Ozan Varol wrote about this in his last post, “3 Ways to Be Insufferable In Coversation.”  They are:  1. Always turn the conversation back to yourself; 2. Pretend to listen; and 3. Ask no questions.  How many people have you already met today who do this on the regular?  If you’re honest, how many times today have you committed these relational sins?  It’s okay, we all do it sometimes.  As GI Joe says, knowing is half the battle.  The other half is doing something about it!

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Smart Museum of Art, Chicago, July 2019

So what do we do?

First, Attend.  Pay attention.  How much time do I spend on social media?  What do I get out of it?  When does Fear Of Missing Out (FOMO) drive my scrolling?  Am I really connecting?  Or am I stalking, comparing, judging, flaming, agitating the echo chamber, and otherwise wasting time and energy?  How can I set alerts and redirect my routine?

Second, Intend.  What is the best use of my time?  If I want to see how my friends are doing, rather than check my Facebook feed, why not call them up?  Send a text, photo, or—gasp—a handwritten note just to say hi, I’m thinking of you?  It may cost you time, energy, and $0.55 in postage.  But aren’t your real friends worth the investment?  You can do it on social media too—if you slow down and think about it first.  Consider the return—brightening someone’s day, feeling that personal connection.  Dopamine drives FOMO, and is also associated with addictive behaviors.  Bonding behaviors elevate oxytocin, the hormone that mediates empathy, safety, and connection.  There is even evidence that higher levels of oxytocin correlate with increased longevity of romantic relationships, or even a person’s own life span (could not find a reliable, peer-reviewed source for this claim—I just believe it intuitively).

Third, Get Curious.  This was the first skill I (re)learned in life coaching, ‘way back in 2005, and it serves me well every single day.  If we let go of the competitive, scarcity-based thinking that surrounds us, what more could we learn?  What novel and inspiring stories could we hear from anyone we meet, or even our closest friends?  If we listen to understand rather than to reload and refute or one-up, what vexing problems could we solve, together?  Just wondering about it makes me feel lighter and more optimistic, what about you?

Subscribe to Ozan’s newsletter, the Weekly Contrarian, to get his list of solutions to conversation insufferability this Thursday, 9am Central Time (I have no financial interests in Ozan’s site; I just really admire his work and the community of critical thinkers he has convened).  And today, I challenge us all:  Monitor our attitudes and facial expressions.  Manage our self-absorption for a few minutes at a time.  Look strangers in the eye and smile as if they’re already our friends.  Ask a Facebook friend what they did this weekend that really made them feel alive and well.  Let’s all get our caring on, shall we?

 

Shoots in the Poop

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It’s December 4th… Time to look back?  Honestly, I’d rather just get this year over with and move on,  because I have already been looking back all this time.  Since January I have counted—weeks and months since the knee injury, months since starting the new job, since surgery, since a spring crisis, since the last this or the first that.  What was it all for?  I think I was just reminding myself that there’s been a lot going on, reassuring myself that I’m not just whining, not being weak for letting my personal health habits slip.

I’ve felt like a relative slug for the last 6 months, despite my best efforts.  I think I must have eaten a pint of ice cream every two days for most of the spring and early summer.  Looking back on the calendar, I stopped using smiley stickers to mark workouts around July—their intensity was only worth hand-drawn smileys.  By and since August they aren’t worth smileys at all—I just jot down what I did in shorthand.  Some weeks it was barely anything.   I judge myself every day—perhaps less harshly than I might have a few years ago, and also less compassionately than I might a few more years from now.  I still struggle with the fear of self-indulgence if I allow myself too much self-compassion.  I am still learning self-compassion.  I know it takes time to rewire our limbic brain patterns with knew learnings from our cognitive brains.  So I will keep trying, because I know it’s helping.  And I’m modeling for the kids.  We can do our best and still fail.  The key is to keep moving.  We can practice admitting we need help, seek it from the appropriate sources, lean on it heavily, and stand back up eventually.  And then we remember those who helped us, and prepare to be helpful in return.

I have leaned on so many this year, I feel almost speechless at the outpouring of support and love.  The only way I don’t collapse from this weight of gratitude is by storing it like a battery—ready to be discharged, full power, when someone needs to plug into me.  This may be my favorite thing about humanity—that we are wired to connect so tightly, to help one another in webs of mutual love and kindness that can extend ad infinitum.

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So I’ll look back a little.  This week I feel a turning.  Did I say this already recently?  Oh yes, it was November 12.  I was making more room for books, trying to stay off of my phone, off of Facebook.  Being on the laptop every night to post to the blog stymied that last part, but it also bought awareness of how I find loopholes in the best plans for self-discipline.  And the daily writing practice also contributed loads to this internal revolution.  This was my fourth year doing NaBloPoMo.  It was by far the most fun, the smoothest, and the most rewarding attempt yet (I think I also said this last year?), and now I miss writing every day (definitely have not said this before).  Maybe it was the daily dopamine hit of views and likes.  But I think it’s more than that.  Through the daily discipline, I had a chance to process and synthesize so many ideas and connections that had been marinating for months, maybe even years.  I practiced prioritizing, selecting, and distilling those ideas into about 1000 words each day, more for my own benefit than anyone else’s.  That people read and related to them was definitely a happy bonus.

Besides NBPM, I attribute this turnaround to two books that Donna recommended to me earlier this fall:  Leadership and Self-Deception and The Anatomy of Peace, both by The Arbinger Institute.  I have wanted to write about them for the last several weeks, but I haven’t yet figured out how to prioritize, select, and distill the lessons coherently.  The foundational ideas are not necessarily new, but they are profound.  The books are written as modern allegories, and there is just something about the metaphors and analogies that has unlocked and integrated everything I have learned about inner work, communication, relationships, and leadership to date.  And that is saying a lot.  Because of these books, the daily writing, and all the conversations I’m having (with myself and with others) as a result of both, the two most challenging relationships in my life right now have fundamentally improved—mostly because I have been able to shift my own attitude.  As with all things, this new ‘way of being’ will take practice.  I need to keep the training wheels on for a while yet.  But now that I have made this turn, the path looks straight, and I see light.

The manure has piled on all year.  So much fertilizer, oh my gosh.  It’s done its job, though, because I have definitely grown.  I feel strong, healthy shoots of green popping out through the thick, dark carpet of poop.